Streptomycin for Penicillin-Resistant Subacute Bacterial Endocarditis

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ALTHOUGH penicillin is the drug of choice for the treatment of subacute bacterial endocarditis due to nonhemolytic streptococci, there is a group of cases in which the antibiotic agent fails to arrest the infection. In some of these cases the organism is resistant to penicillin from the beginning, while in others resistance apparently is acquired during the course of therapy. Treatment, in the former instances, does not affect the fever or the clinical course of the illness, but in cases belonging to the latter group, the evidence of infection is temporarily controlled, only to relapse while the drug is still being administered or shortly after it has been discontinued. Hunter1 has recommended that streptomycin be employed in the treatment of these penicillin-resistant cases, and the present report summarizes two instances in which therapy of this kind successfully controlled the infection.

Case Reports

Case 1. A white man, aged 42, had had several teeth removed two and one-half months before his first visit to the Clinic. Approximately twelve hours after the extractions he experienced a severe chill followed by fever. Six weeks later, because of increasing weakness and fatigue, persistent afternoon fever, and frequent night sweats, he was admitted to a hospital. A blood culture yielded a growth of Streptococcus viridans, and an unknown amount of penicillin was administered by intramuscular injection every three hours for three and one-half days. He was then discharged, but the fever and other symptoms returned within two or three days. Three weeks later he was. . .



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